In-Home Services for Families of LGBTQ Youth

Home , Family support

Because transgender people are often marginalized in In-Home Services for research, practice and policy, with people adding the “T” to “LGBQ” without promoting real inclusion, this bulletin Families of LGBTQ Youth uses “LGBTQ” only when the research and practice models By Diane E. Elze, Ph.D. substantively incorporate transgender youths; otherwise, University at Buffalo “LGB” will be used. When used, the term “sexual minority” encompasses more diverse expressions of sexuality School of Social Work and gender variance, and includes self-identified lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) adolescents, and youths who are gender variant and/or ex- INTRODUCTION perience same-sex attractions, relationships, and/or behaviors without necessarily labeling themselves. Efforts to improve child welfare services for lesbian, gay, bisexual, transgender and queer and questioning youths SCOPE OF THE PROBLEM have largely focused on improving conditions for LGBTQ LGBTQ youths are believed to be disproportionately youths in out-of-home care. Although child welfare experts represented among young people in out-of-home care have long advocated that LGBTQ youths receive family and among runaway and homeless youths because of the centered services (DeCrescenzo & Mallon, 2002; Mallon, increased likelihood they will be thrown out, harassed, 1999; Mallon & DeCrescenzo, 2009), LGBTQ youths have assaulted or rejected by caregivers who negatively react to yet to benefit from federal mandates for family support their sexual orientation and/or gender identity (Sullivan, services and permanency planning (Jacobs & Freundlich, Sommer, & Moff, 2001; Woronoff, Estrada, & Sommer, 2006; Mallon, Aledort, & Ferrera, 2002; Wilber, Ryan, & 2006), subsequently leading to involvement with the juve- Marksamer, 2006). nile justice system for status offenses or street-connected The ever-expanding array of school- and community- crimes (Majd, Marksamer, & Reyes, 2009). based services for LGBTQ youths throughout the country However, it is important to note that most lesbian, gay and largely exclude families from core services. Although these bisexual adolescents are functioning quite well, enjoying diverse programs provide valuable recreational, mutual psychological, emotional, physical, and social well-being support and socialization experiences for LGBTQ youths, (Russell, 2005; Savin-Williams, 2005), just like the ma- they typically focus on the youths as individuals rather than jority of adolescents (Irwin, Burg, & Cart, 2002). Sexual serving them within their family contexts (Jacobs & Freud- minority youths, like other adolescents, traverse a variety enlich, 2006; Mallon 1999; Mallon et al., 2002; Wilber et of developmental trajectories (Diamond, 2003; Rosario, al., 2006). Schrimshaw, & Hunter, 2011a), and their lives involve Propelled by research from the Family Acceptance complex interactions with multiple environments that ex- Project,TM (Ryan, 2010), a paradigm shift is occurring pose them to continua of risk and protection (Elze, 2007). that challenges service providers to fully engage with the Like their heterosexual and non-transgender peers, LG- family members of LGBTQ youths as potential allies BTQ youths in out-of-home care (Wilber et al., 2006) and capable of increasing their support and acceptance of their those who are homeless (Ray, 2006; Rosario et al., 2011b) LGBTQ children. This bulletin provides a rationale for are among the adolescent populations most at-risk. While early intervention with families of LGBTQ youths in order less is known about transgender youths, compared to LGB to strengthen families; prevent out-of-home placement, youths, emerging research shows a pattern of heightened runaway behavior, and youth homelessness; and promote risk and vulnerability within their families, schools and positive developmental outcomes for LGBTQ youths. communities (Greytak, Kosciw, & Diaz, 2009; Grossman &

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D’Augelli, 2007; Grossman, D’Augelli, Howell, & Hub- whom 66% were youths of color, 35% identified as LGB bard, 2005), particularly for transgender youths of color (Clatts, Davis, Sotheran, & Atillasoy, 1998). Van Leeuwen (Garofalo et al., 2006), and poor treatment at the hands et. al (2006) conducted a same-day public health survey in of service providers (Greytak et al., 2009; Grossman & eight cities across six states in order to measure and com- D’Augelli, 2006; Mallon & DeCrescenzo, 2009). pare risk factors between LGB and non-LGB homeless youths. Nearly one-quarter (22.4%) of the 670 participants Demographics identified as LGB and significantly more LGB youths than non-LGB youths (44% versus 32%) reported having been LGBTQ youth in child welfare systems. We do not know in the custody of social services. More recently, in a count how many LGBTQ youths are involved with child welfare of 945 homeless youths, ages 13 to 24, in New York City, systems, as they comprise a largely invisible population. youths of color (74.5%), and LGBT youths (33.7%) were They often hide their sexual orientation and/or gender iden- disproportionately represented, compared to their represen- tity out of fear of receiving differential treatment and nega- tation in the general population of young people (Freeman tive reactions from parents, other caretakers and profession- & Hamilton, 2008). als, (DeCrescenzo & Mallon, 2002; Gallegos et al., 2011; Mallon, 1999; Ragg, Patrick, & Ziefert, 2006; Sullivan et al., ROLE OF SEXUAL ORIENTATION AND GENDER 2001; Woronoff et al., 2006), or upon the advice of program IDENTITY IN YOUTH HOMELESSNESS, RUNAWAY staff who encourage them not to disclose for their own safety BEHAVIOR, AND CHILD WELFARE (Berberet, 2006). INVOLVEMENT

Estimates of LGBT youths among foster care and juvenile Like their heterosexual peers, LGB youths find themselves justice populations have ranged from 4% to 10% (Feinstein, involved with child welfare systems and/or experience Greenblatt, Hass, Kohn, & Rana, 2001; Sullivan, Sommer, homelessness due to family conflict, parental abuse and/ & Moff, 2001), up to 20% to 60% (Woronoff et al., 2006). or neglect (Thrane, Hoyt, Whitbeck, & Yoder, 2006; Tyler, These latter figures, however, were based on the percep- Hoyt, Whitbeck, & Cauce, 2001), parental substance abuse tions of youths in careand adult service providers , rather and mental illness, or death of a caretaker (Wilber et al., than on empirical research (Woronoff et al., 2006)1 Two 2006). Other LGBTQ adolescents enter out-of-home care needs assessments with youths in the California juvenile as infants or young children, where they later discover their justice system, one involving 230 male and female youths sexual orientation and/or gender identity (DeCrescenzo & in Santa Cruz County and the other with 176 young women Mallon, 2002; Mallon, 1998, 1999; Mallon et al., 2002; in Sonoma County, found that 13% to 14% identified as Wilber et al., 2006). gay/lesbian, bisexual or unsure about their sexual orientation (Irvine, 2010). Unlike their heterosexual and gender-conforming peers, LGBTQ youths may face familial rejection in response to In a longitudinal study of youths aging out of the child their sexual orientation and/or gender identity and gender welfare system in three Midwestern states, Courtney and expression. Heterosexism in families can directly result colleagues found that 6.6% of the young people self- in the youth’s ejection from the home, or it can exacerbate identified as “bisexual,” “mostly homosexual,” or “100% other parental problems, heightening familial conflict until homosexual” at age 19 (i.e., 4.8% of the young men and the youth is kicked out or leaves (DeCrescenzo & Mallon, 8.3% of the young women), higher than the proportion of 2002; Mallon, 1998, 1999; Mallon et al., 2002; Mallon & youths that responded similarly in Wave 3 of the National DeCrescenzo, 2009). Multiple studies show that lesbian, Longitudinal Study of Adolescent Health (i.e., 3.4%: 2.8% gay and bisexual youths experience more physical and of young men and 3.9% of young women) (Courtney et al., verbal abuse and harassment from family members dur- 2005). By ages 23 or 24, of the young people formerly in ing adolescence than their heterosexual peers (see Ritter & care, 11.2% of the young women and 3.9% of the young Terndrup, 2002; Ryan & Futterman, 1998; Saewyc et al., men self-identified as “bisexual,” “mostly homosexual,” 2006 for overviews). or “100% homosexual,” and an additional 2% reported that they were unsure of their sexual orientation (Courtney, Little is known, however, about the numbers of LGBTQ Dworsky, Lee, & Raap, 2010).2 youths who runaway from or are kicked out of their families. Of 400 LGBTQ and HIV-positive youths, ages 12 to Lesbian and gay homeless youths. Multiple studies with 24, living in out-of-home care or homeless in San Diego, homeless youths suggest that approximately 20% in the 39% reported having been kicked out of their homes or larger magnet cities identify as lesbian, gay, or bisexual, placements due to their sexual orientation or gender iden- with smaller representations of sexual minority youths tity (Berberet, 2006). Compared to their heterosexually- outside of large urban areas (Whitbeck, Chen, Hoyt, Tyler identified peers, LGB homeless youths report a higher & Johnson, 2004). In a study of 929 homeless and street- prevalence of physical and sexual victimization prior to connected youths, ages 12 to 23, in New York City, of leaving home (Rew, Whittaker, Taylor-Seehafer, & Smith, 2 National Resource Center for In-Home Services

2005; Whitbeck, Chen et al., 2004). The FAP found that the rejecting behaviors of some families (e.g., blocking access to LGBT peers and resources, When separated from their families, LGBTQ youths’ discouraging disclosure, criticizing dress) were grounded in subsequent homelessness, truancy from school, and sub- parental care and concern, such as a desire for their child to stance abuse and mental health problems often precipitate be safe, and accepted and respected by others (Ryan, 2009, their involvement with the juvenile justice and/or foster 2010). Young people, however, experience such behaviors care systems (Majd et al., 2009; Wilber et al., 2006). Forty- as unsupportive, at best, and hateful, at worst. Research five percent of the youths in the San Diego study reported has found that families typically become more accepting involvement with the juvenile justice system, and 65% over time (D’Augelli, Grossman, & Starks, 2005), and had been in a foster home or group home (Berberet, 2006). that the outcomes for youth with ambivalent families are Compared to their heterosexually-identified peers, LGB significantly less severe, compared with youth from highly homeless youths report higher rates of substance abuse, rejecting families (Ryan et al., 2009). mental health problems, risky sexual behaviors, and physical and sexual victimization on the streets (Cochran et al., The FAP is working closely with diverse religious insti- 2002; Van Leeuwen et al., 2006; Whitbeck, Chen et al., tutions and clergy, such as Mormon religious leaders, to 2004; Whitbeck, Hoyt, Johnson, & Chen, 2007). disseminate its research findings. The project is developing a series of educational materials for families from diverse THE IMPACT OF FAMILY REJECTION AND FAM- religious backgrounds. A cornerstone of the family inter- ILY ACCEPTANCE ON LGBTQ YOUTHS vention model is helping families balance deeply held reli-

TM gious beliefs with love for their LGBT children (C. Ryan, Emerging research from the Family Acceptance Project personal communication, October 26, 2011). provides compelling evidence that family rejection severely impacts health and mental health outcomes for LGBTQ RESEARCH-BASED, FAMILY-FOCUSED youths (Ryan, Huebner, Diaz, & Sanchez, 2009). Through INTERVENTIONS extensive community-based research with youths and families, the FAP identified more than 100 specific accept- Research-based interventions developed by the Family ing and rejecting behaviors used by family members when Acceptance ProjectTM aim to reduce the rejecting behaviors reacting to their children’s identity. Ryan and colleagues and increase the accepting behaviors among ethnically-, (2009) found that non-Latino white and Latino LGB young educationally-, and religiously-diverse families. These adults that experienced high levels of family rejection interventions are based on FAP’s extensive research with during adolescence, as compared to low or no levels, were LGBT youths, young adults and families which has identi- 8.4 times more likely to report suicide attempts, 5.9 times fied specific behaviors that parents and other caregivers use more likely to report high levels of depression, 3.4 times to express acceptance and rejection of their LGBT children, more likely to use illegal drugs and 3.4 times more likely to and has linked each of these behaviors during adolescence participate in unprotected sex. to physical and mental health and well-being in young adulthood. FAP research indicates that decreasing family Additionally, they found that LGBT Latino and non-Lati- rejecting behaviors and increasing support can decrease no white young adults that had experienced greater family serious health and mental health risks. acceptance as adolescents also reported higher self-esteem, better overall health, more social support, and less depres- FAP is developing family-focused intervention strate- sion, suicidality and substance abuse than their less accept- gies, resources and tools that can be used by health, mental ed peers, although transgender young adults reported less health, social service and school-based providers across social support and poorer general health (Ryan, Russell, disciplines and systems of care. With this approach, and Huebner, Diaz, & Sanchez, 2010). using FAP assessment tools, at-risk LGBT youths can be identified and families can receive help in increasing THE PROMISE OF IN-HOME SERVICES FOR family support, decreasing risk, reducing conflict, main- LGBTQ YOUTHS AND THEIR FAMILIES taining youths in their homes, and reconnecting families after disruption occurs. An important aspect of this work It is critical that child welfare workers realize that families is educating families about the physical and mental health struggle to adapt to their LGBTQ child’s sexual orientation risks associated with specific behaviors. With intervention, and/or gender variance, and that concerns for their child’s parents and other caregivers can modify rejecting behav- well-being often underlie the negative reactions of parents iors and reduce family conflict over youths’ sexual and/or and other caretakers. Many families want information and gender identity and expression. desire a resolution of conflict related to their child’s sexual orientation and/or gender variance (Ryan, 2009, 2010).

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THE CRITICAL NEED FOR IN-HOME SERVICES PROMISING PROGRAM MODELS FOR LGBTQ YOUTHS AND THEIR FAMILIES The following are examples of promising intervention ap- Child welfare professionals urgently need training to help proaches with families of LGBTQ youths and multi-level families work through their questions and concerns related strategies to transform service delivery systems. to sexual orientation and gender identity diversity, and to facilitate family acceptance and reunification when pos- Developing Evidence-based Interventions with LGBTQ sible (Mallon et al., 2002). Early intervention may prevent Youths and Families and Transforming Service Delivery family disruption over sexual orientation or gender identity Systems

issues and decrease the likelihood that families will break TM apart. Workers can play a critical role in helping LGBTQ Family Acceptance Project youths maintain attachments to supportive extended family San Francisco State University members (Mallon et al., 2002). San Francisco, CA Caitlin Ryan, Ph.D., Director Intensive home-based services can alleviate crisis situ- 415-522-5558 ations that may arise when parents or other caretakers http://familyproject.sfsu.edu discover that a youth is LGBTQ, with the goal of keep- Email: [email protected]

ing the family intact if the youth’s safety can be assured TM (DeCrescenzo & Mallon, 2002; Mallon, 1999; Mallon et The Family Acceptance Project , (FAP), a comprehen- al., 2002; Wilber et al., 2006). Child welfare professionals sive community-based research, intervention, education and must dissuade parents and other caretakers from seeking policy initiative, is developing innovative and evidence- harmful and unethical reparative therapies which aim to based intervention strategies that can be implemented in change youths’ sexual orientation or gender identity (Mal- multiple settings and service delivery systems with ethni- lon & DeCrescenzo, 2009). Families need accurate infor- cally-, educationally- and faith-diverse LGBTQ youths and mation about sexual orientation and gender identity within their families. Home-and community-based interventions the context of normal adolescent development; supportive that are focused on education, skill-building, family coun- guidance to help them adjust to their child’s identity; and seling and peer support comprise most of its intervention empathic counseling to address their negative and posi- work. Evidence-based family support services provided tive feelings, attitudes, and behaviors towards their child’s in English, Spanish, and Cantonese have been available sexual orientation and/or gender identity (Ryan et al., 2009, in collaboration with Child & Adolescent Services at San 2010; Wilber et al., 2006). Francisco General Hospital/UCSF. Referrals come from providers across service systems, and families can also self- Footnotes refer. A primary aim of FAP is to change the paradigm of care from serving LGBTQ youths either alone or through 1 Drawing meaningful comparisons across research studies, peer support to providing services in the context of their however, is complicated by the wide variation in conceptu- families. al and operational definitions of sexual orientation (Saewyc et al., 2004). More people endorse same-sex behaviors, FAP has been developing a series of resources to help attractions and desires than self-identify as gay, lesbian or diverse families support their LGBTQ children. These bisexual (Laumann, Gagnon, Michael, & Michaels, 1994). include family education booklets available online and in hard copy in English, Spanish and Chinese (Supportive 2These proportions exceed those of young adults who iden- Families, Healthy Children: Helping Families with Lesbi- tified as gay, lesbian or bisexual (1.4% of young women an, Gay, Bisexual & Transgender Children [Ryan, 2009]); a and 2.8% of young men) in the National Health and Social family video series that shows the process by which ethni- Life Survey, a comprehensive survey of adult sexual behav- cally and religiously diverse families learn to support their ior (Laumann et al.,1994). LGBTQ children (one of these films, “Always My Son,” is an award-winning short documentary film that chronicles a Mexican-American family’s journey towards accepting their gay son and changing their community); and assessment tools. Additional intervention materials are under development, including educational booklets with lower literacy versions, and the rest of the family video series for use with families of different ethnic backgrounds and faith traditions.

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FAP has developed an empirically derived risk assessment Models for Intervening with LGBTQ Youths and tool (FAPrisk Screener) that enables providers to ask LG- Families BTQ youths about specific family reactions to their LG- BTQ identity which FAP research has found to be highly Family Involvement Center predictive of poor outcomes among LGBTQ youths, in- Phoenix, AZ cluding depression, suicide attempts, substance use related 602-412-4095 problems and sexual health risk. With the screener, clini- http://familyinvolvementcenter.org cians trained in its use can identify LGBTQ youths who are experiencing high levels of parental rejection and intervene The Family Involvement Center, licensed by the Ari- to improve outcomes. zona Office of Behavioral Health, is gradually integrating LGBTQ-related information into its array of parent sup- FAP is also available to provide consultation and training port services, although targeted outreach to the families of to agencies and organizations interested in improving their LGBTQ youths has not yet been accomplished. service delivery to LGBTQ youths and their families, and in implementing the research-based intervention strategies Services are aimed at parents who are raising a child with developed by FAP. FAP has worked with several jurisdic- emotional, mental health and/or behavioral challenges. tions to initiate new family-related services for LGBTQ Trained Parent Partners, with personal experience raising youths, based on FAP’s research and family approach. children with emotional, mental health and/or behavioral challenges, and skills in navigating service delivery sys- R.I.S.E. Initiative (Recognize, Empower, Support, tems, provide short-term, one-on-one, parent-to-parent Intervene) support in the home or in community locations, depending A Service of the Children’s Bureau, ACYF, ACE De- upon the parents’ preference. Parent Partners serve an aver- partment of Children, Youth & Family Services age of 200 parents annually. The FIC has trained its Parent L.A. Gay & Lesbian Center Partners in LGBTQ issues and a Parent Partner sits on the Los Angeles, CA community-based LGBTQ Consortium in Phoenix. Youth Lisa Parrish, Director Mentors are young adults who provide support to teens in 323-860-3600 areas such as life skills. http://www.lagaycenter.org Email: [email protected] In addition to individual support, services include group interventions, such as the Strengthening Multi-Ethnic The R.I.S.E. Initiative, funded by a 5-year grant from the Families and Communities through Violence Prevention; Children’s Bureau Permanency Innovations Initiative, is weekly and monthly support groups; book discussions on creating a system of care to promote better permanency parent- and youth-related issues; the Parent Assistance Line outcomes for LGBTQ youths at-risk for long-term foster (PAL) which provides parent-to-parent telephone support care. RISE is developing interventions to create age ap- in English and Spanish; and coaching and mentoring to propriate Outreach Protocols to help child welfare staff involve families in systems-level change. create a safe environment in which children and youths feel comfortable expressing their whole identity, includ- Family Therapy Intervention Pilot Project (FTIP) ing gender non-conformity and sexual orientation, as well Green Chimneys and SCO Family of Services as a confidential identification survey to measure LGBTQ Green Chimneys NYC Division, LGBTQ Youth prevalence in out-of-home care. Using a wraparound Programs, model, RISE is creating four Center-based care coordina- 718-732-1501 tion teams that will use family finding, engagement, and http://www.greenchimneys.org acceptance strategies to serve 40 youths at risk of long-term foster care. With consultation and training from the Family SCO Family of Services, Brooklyn, NY, LGBTQ Acceptance ProjectTM, the teams will help agency partners Program, implement interventions with families to increase support 718-935-9466 for and decrease rejection of their LGBTQ children, and to http://www.sco.org. increase durable permanent connections. Ultimately RISE plans to train Wraparound teams at partner agencies in Los The Family Therapy Intervention Pilot Project (FTIP) is a Angeles on this developing LGBTQ-affirming and perma- collaborative between Green Chimneys and SCO Family of nency-focused care coordination model. The initiative will Services, two multi-service youth agencies with a long his- provide ongoing training and coaching to caregivers and tory of serving LGBTQ youths in out-of-home care through agency staff through a new Training and Coaching Institute, group homes, independent living programs, foster homes, which will also act as a clearinghouse on LGBTQ-affirming and transitional housing facilities. Funded by private dona- child welfare training materials. tions administered by the New York City Department of Youth and Community Development (NYC-DYCD), the 5 National Resource Center for In-Home Services

FTIP aims to develop and expand the permanency resourc- Funded entirely by the Ontario Ministry of Children and es for LGBTQ youths involved with the DYCD-funded Youth Services, OK2BME provides individual and family continuum of services for runaway and homeless youths counseling, and psychoeducational and therapeutic recre- (e.g., shelters, drop-in centers, street outreach programs, ational groups for youth. Although the majority of clients and transitional housing). Participating youths may be are youth, approximately 25% are parents. Counselling homeless or at-risk of homelessness. approaches used include narrative, solution-focused, and client-centered practice models. The program is serving an Family therapists will deliver an in-home 12 to 15-week increasing number of children with LGBTQ parents, and family therapy intervention with follow-up one month after younger children with gender non-conforming behaviors, the last session. Families can also select to receive the in- along with their parents. OK2BME provides considerable tervention in a community setting of their choice. The fre- training in the Waterloo Region to school personnel, Chil- quency of visits will vary with the family’s needs. During dren’s Aid workers, and other social services professionals. the one year pilot, each agency will work with 15 families. The goal is to increase family acceptance of the youth and Parent-Teen Mediation Program to strengthen intrafamilial relationship regardless of where Kitchener-Waterloo, Ontario the youth may be living. The intervention model draws Canada upon Multisystemic Family Therapy, psychoeducational Sherri Bean approaches, and consultation from the Family Acceptance 519-572-7807 Project.TM Email: [email protected]

The FTIP was a direct result of recommendations made by The Parent-Teen Mediation Program aims to prevent the New York City Commission on Lesbian, Gay, Bisexual, youths, ages 12 to 15, from entering out-of-home care. All Transgender and Questioning Runaway and Homeless referrals come from Family and Children’s Services of the Youth, one of which was to develop pilot programs to Waterloo Region with services funded by the provincial enhance family support for LGBTQ youths and prevent or government. (Note: In Canada, youths can no longer enter shorten the duration of homelessness. Convened by the care when they reach 16 years of age.) Since 2001, the pro- NYC-DYCD with members appointed by Mayor Michael gram has served between 400 to 500 families and conducts R. Bloomberg, the Commission was charged with address- about 50 mediations annually. Although not directed solely ing the unique needs of LGBTQ youths within families and at LGBTQ youths and their families, underlying issues other systems, developing innovative strategies to prevent related to sexual orientation or gender identity may emerge homelessness among LGBTQ youths, and improving ser- in the mediation process. The program seeks to reduce vice delivery to LGBTQ youths and their families. Private parent-child conflict, improve family functioning, increase donations to the Mayor’s Fund to Advance New York were parental understanding of adolescent developmental norms, forwarded to NYC-DYCD to support the development of enhance communication and parenting strategies, and pro- pilot programs. mote positive family interactions.

OK2BME The Parent-Teen Mediation Program uses a formalized KW Counselling Services, Inc. mediation approach, based on mutual empathy, for open- Kitchener, Ontario ing up difficult conversations between parents and their Canada children. Each family receives two individual counselling 519-884-0000 sessions for the teen and two for the parent(s). Individual http://www.kwcounselling.com sessions are highly empathy-based and include mini- http://www.OK2BME.ca teachings for the parent or youth on a variety of topics (e.g., boundaries, empathy, parenting techniques). At the end of Outreach and Support Services for LGBTQ Children every individual session, each parent and teen is asked to and Youth (OK2BME) provides free services to LGBTQ make a commitment to change one behavior that they know children and youth, ages 5 to 18, and their families in the would make the situation better for the other. These indi- Waterloo Region of Ontario, Canada. A collaborative be- vidual sessions are then followed by four mediation ses- tween KW Counselling Services, a large multi-service fam- sions between the youth and parent(s) in which the list of ily counselling agency, and Family and Children’s Services issues identified during the individual counseling sessions of the Waterloo Region, the local Children’s Aid Society, are mediated. Mutually agreed upon contracts are given to OK2BME was developed to prevent an increasing number the teen and parent(s) at the end of each mediation session of LGBTQ youths from entering out-of-home care. Most referrals come from schools and approximately 25% from Children’s Aid Societies.

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Parent Solutions at power in their relationships with clients. Although most Campbell, CA services are delivered on-site, agency staff and volunteers 408-292-4357 (HELP) can sometimes meet with individuals and families in other http://www.ps-ca.com community locations. Integrative health services delivered by professional practitioners who volunteer their time helps Parent Solutions provides one-on-one in-home parent edu- young people heal from acute and chronic trauma. Other cation and coaching for families challenged by any number community volunteers facilitate support groups, such as of issues (e.g., substance abuse, domestic violence; di- the RECLAIM Families Group which meets monthly for vorce, separation, or blending; financial stress; child abuse youths exploring their gender identity and the people who and/or neglect and child protective services involvement; love them. RECLAIM’s services are funded through grants, child behavioral challenges), including parenting LGBTQ insurances and donations. youths. A Parent Coach assesses the family’s needs and concerns and develops a schedule of services in partnership Strengthening Programmatic Focus on Families of with the family. Currently operating as a for-profit agency, LGBTQ Youths in Residential Programs Parent Solutions’ fees for services vary based on a sliding fee schedule and the referral source. Referrals come from Waltham House agencies such as the Department of Family and Children’s The Home for Little Wanderers Services and Victim Witness, and families can self-refer. Waltham, Massachusetts Parent Solutions serves an ethnically diverse population 1-888-HOME-321 and can provide coaches that speak languages other than http://www.thehome.org English. The frequency of in-home visits depends upon Email: [email protected] the severity of the issues and may range from monthly to multiple weekly visits. Individual intervention approaches Waltham House, the first residential group home in New include psychoeducational strategies, family therapy, and England developed specifically for LGBTQ youths, is one case management. Group interventions held in community of several residential programs of The Home for Little spaces include the Parent Project®, a training model for Wanderers, the oldest non-profit child and family service parents of adolescents engaged in destructive behaviors, the agency in the country and the largest in New England. Family Wellness Survival Skills program, and a curriculum Since 2002, Waltham House has provided a safe and sup- developed by Parent Solutions to address the most common portive group home environment for up to 12 LGBTQ dilemmas outlined on goal plans during the one-on-one youths, ages 14 to 18, preparing residents for family reuni- parent coaching and designed to address the needs of the fication or independent living. The program offers an array served population. Parent Solutions also provides training of therapeutic, psychoeducational, recreational, life skills, to child welfare agencies, foster parents, and residential and educational programs. Individual, group and family care staff on addressing the needs of LGBTQ youths in out- therapy are available, with cognitive-behavioral therapy as of-home care. the primary practice model. Youths’ lengths of stay range from 9 to 18 months, depending upon whether reunification RECLAIM or independent living is the goal. Over the past few years, Minneapolis, MN the program has strengthened its efforts to engage youths’ Janet Bystrom, Executive Director family members and approximately 50% of the youths have 612-235-6743 immediate family members involved in their lives. In-home http://reclaim-lgbtyouth.org services are available from The Home for Little Wanderers’ Child and Family Counseling Center and the Safe at Home RECLAIM aims to increase mental health support to program. In its work with families, Waltham House aims to LGBTQ youths and young adults, ages 13 to 25, through increase family acceptance of the LGBTQ youths, reunify individual and family counseling, integrative health ser- the family when possible, and assist family members in vices (e.g., acupuncture, massage, chiropractic) and support maintaining healthy and supportive connections if they can- groups, so that youths may “reclaim their lives from op- not live together. pression in all its forms.” RECLAIM serves an ethnically diverse population of young people and utilizes volunteers Initiatives Focused on Transforming Service Delivery who are visible within and connected to ethnically diverse, Systems underserved communities (e.g., Native American, Hmong, transgender). These volunteers often act as “cultural Minnesota Department of Human Services brokers,” helping agency staff engage with families around Child Safety and Permanency Division LGBTQ issues in culturally relevant ways. Counseling Child Welfare Training System services are grounded in a narrative therapy approach Connie Abbott, Social Services Consultant which invites conversation about the impact of oppression 651-431-4693 on people’s lives and challenges clinicians to look critically Email: [email protected] 7 National Resource Center for In-Home Services

A small group of staff in the Minnesota Department of acceptance and affirmation of LGBTQ children, youths and Human Services Child Safety and Permanency Division are families, toward the goal of achieving positive outcomes writing a comprehensive practice guide for working with and equity. The manual is available for a nominal cost. LGBTQ youths and their families who are involved with Within CAS of Toronto, training on sexual orientation, the child welfare system. The project emerged from grow- gender identity and gender expression is mandatory for all ing concern about the number of homeless youths with pre- workers and foster parents. vious involvement in the child welfare system. The aim of the project is to improve service delivery at all levels (e.g., Putting Pride into Practice Project (P4) LGBTQ-affirming foster homes, supportive residential care A program of Family Builders environments, and enhanced family preservation and reuni- Rob Woronoff, Project Director fication efforts). The guide incorporates specific content on 510-435-3724 family preservation and reunification, relationship-building http://www.familybuilders.org/p4 with LGBTQ youths and their families, LGBTQ youth homelessness, coming out processes, mental and physical Family Builders is dedicated to finding permanent, nur- health needs of LGBTQ youths, and strategies for assist- turing families for children and youths in the foster care ing youths and families in rural communities, among other system. Putting Pride into Practice Project (P4), a program topics. The team is receiving technical assistance from of Family Builders since July 2010, is designed to improve the National Resource Center for Permanency and Family systems of care for LGBTQ youths in the California child Connections. When completed, the guide will be available welfare system through policy advocacy, consultation, and for download through the department’s electronic docu- training of caseworkers and foster parents. Funded by a ment system. Additionally, a new curriculum, “Working private foundation, the project currently works with four with GLBTQ Youth and Their Families,” has been piloted counties (i.e., San Francisco, Orange, Fresno and Santa and will be offered in all Minnesota county and tribal child Clara) to implement the Child Welfare League of America’s welfare agencies when revisions are completed. best practice guidelines for serving LGBTQ youths in out- of-home care. The guidelines emerged from the Model Out and Proud Program Standards Project, a collaboration between Legal Services Children’s Aid Society of Toronto for Children and the National Center for Lesbian Rights. Toronto, Ontario The project integrates findings from the Family Acceptance Canada Project TM when training professionals on strategies for 416-924-4640 X2986 or 2987 working with the families of LGBTQ youths. http://www.torontocas.ca/main.php/?cat=40 Email: [email protected] The Safe Harbor Project True Colors, Inc. Sexual Minority Youth and Family Since the early 1990s, the Children’s Aid Society of To- Services of Connecticut ronto (CAS of Toronto), one of the largest non-profit child Hartford, CT welfare organizations in North America, has demonstrated 860-232-0050 leadership to ensure the delivery of sensitive and cultur- http://www.ourtruecolors.org ally competent child welfare services to LGBTQ children, Email: [email protected] youths and families. Mandated and funded by the Ministry of Children and Youth Services of the Province of Ontario, The Safe Harbor Project is a collaboration between the CAS of Toronto, through the Out and Proud Program, pro- Connecticut Department of Children and Families, the vides training, consultation, policy development, resource Connecticut Association of Foster and Adoptive Parents, development, and the development and dissemination of and True Colors, Inc. Sexual Minority Youth and Family best practice guidelines related to serving LGBTQ children, Services of Connecticut. Since its inception, the project youths and families. These initiatives are grounded in a has trained approximately 7,000 workers. The project has 2006 Anti-Oppression/Anti-Racism policy that frames the three objectives: (a) to inform policy for the Connecticut agency’s work. The Out and Proud Program has also de- Department of Children and Families to address the needs veloped community-based partnerships to expand LGBTIQ of LGBTQ youths in out-of-home care; (b) to train child service to youths and families in other settings. welfare professionals in the provision of culturally competent services to LGBTQ youths and on the importance of The Out and Proud Program is releasing a new manual, engaging youths’ families; and (c) to provide consultation Out and Proud Affirmation Guidelines, featuring a model to foster families and other care givers of LGBTQ youths. framework and 20 practice guidelines addressing direct A mentoring program primarily targets LGBTQ youths services provision and organizational culture. Many of the in out-of-home care who are referred by DCF; youths are direct practice guidelines are focused on helping families, matched with mentors who develop a relationship with the services and other care providers increase their support, custodial caregivers and, in some cases, parents. Since 1994, True Colors has sponsored an annual conference 8 National Resource Center for In-Home Services that now draws nearly 2,000 young people and 900 adults League of America. (2006). Getting down to basics: (i.e., youth-serving professionals and biological, foster and Tools to support LGBTQ youth in care. New York: Au- adoptive parents); since its inception, the conference has thors. Available from http://www.lambdalegal.org/take- included a special track for parents of LGBTQ youths. action/tool-kits/getting-down-to-basics/

Association for Family and Community Integrity, Inc. Minter, S., & Krehely, J. (2009). Families matter: New Houston, TX research calls for a revolution in public policy for http://www.glbthomeless.org LGBT children and youth. Available from Center for American Progress, http://www.americanprogress.org/ The Association for Family and Community Integrity, Inc. issues/2011/02/pdf/families_matter.pdf/ (AFCI), a 3-year-old nonprofit organization dedicated to serving homeless LGBTQ youths and youths at risk of fam- New York City Commission on Lesbian, Gay, Bisexual, ily breakdown, is leading a new initiative to promote sys- Transgender and Questioning Runaway and Homeless tems change. AFCI is comprised of professional educators, Youth. (June 2010). All our children: Strategies to pre- mental health clinicians, businesspeople, attorneys, social vent homelessness, strengthen services and build support workers, and parents who are involved in community edu- for LGBTQ youth. New York: Author. Available from cation, program development and advocacy on behalf of at http://www.nyc.gov/html/om/pdf/2010/pr267_10_report. risk LGBTQ youths. AFCI Board members have provided pdf extensive training to professionals within the child welfare, juvenile justice, family court, and homeless services sys- Pardo, S.T. (2008, March). Growing up transgender: Re- tems. AFCI is partnering with Kinder Emergency Shelter to search and theory. Ithaca, NY: ACT for Youth Center of provide shelter services to LGBTQ youths, and with Mon- Excellence, Cornell University Family Life Develop- trose Counseling Center, an LGBTQ-focused behavioral ment Center. Available from http://www.actforyouth.net/ health and prevention agency, to provide individual and resources/rf/rf_trans-identity_0308.pdf family counseling. AFCI is developing two training curricula, one for parents of LGBTQ youths and one for young Pardo, S.T., & Schantz, K. (2008, September). Growing up people, both of which will be delivered by volunteers. transgender: Safety and resilience. Ithaca, NY: ACT for Montrose Counseling Center convenes a quarterly LGBT Youth Center of Excellence, Cornell University Family Homeless Youth Summit to identify service gaps and Life Development Center. Available from http://www. coordinate service provision to homeless LGBTQ youths actforyouth.net/resources/rf/rf_trans-resilience_0908.pdf and youths at risk of homelessness. A longer-term goal is to Ryan, C. (2009). Supportive families, healthy children: establish a residential program for LGBTQ youths. Helping families with lesbian, gay, bisexual & transgender children. San Francisco, CA: Marian Wright Edel- RESOURCES FOR FURTHER INFORMATION man Institute, San Francisco State University. Available (Note: Additional resources can be found in the refer- from http://familyproject.sfsu.edu. ence list) Tuerk, C., Menvielle, E., & de Jesus, J. (2003). If you are Books, Fact Sheets, Newsletters, Practice Briefs and Re- concerned about your child’s gender behaviors: A guide search Reports for parents. Washington, DC: Children’s National Medi- cal Center, Outreach Program for Children with Gender- American Psychological Association Task Force on Variant Behaviors and Their Families. Available from Gender Identity, Gender Variance, and Intersex Condi- http://www.childrensnational.org/files/PDF/Department- tions. (2006). Answers to your questions about trans- sAndPrograms/Neuroscience/Psychiatry/GenderVarian- gender individuals and gender identity. Available from tOutreachProgram/GVParentBrochure.pdf http://www.apa.org/topics/sexuality/transgender.pdf World Professional Association for Transgender Health’s Brill, S., & Pepper, R. (2008). The transgender child: A Standards of Care for the Treatment of Gender Identity handbook for families and professionals. San Francisco, Disorders.(2001).(6th version). Available from http:// CA: Cleis Press. www.wpath.org/documents2/soc6.pdf

Hooper, V. (2004, Nov/Dec). Child Study Center Letter: These standards articulate the professional consensus of Gay, lesbian, and bisexual youth: Facing challenges, the World Professional Association for Transgender Health, building resilience. New York, NY: New York University an international organization of health care professionals Child Study Center. Available from http://www.about- specializing in the medical, mental health, and surgical ourkids.org/files/articles/nov_dec_0.pdf management of gender identity disorders among adults and adolescents. Lambda Legal Defense & Education Fund & Child Welfare 9 National Resource Center for In-Home Services

Model Policies and Practice Guidelines calls. To join the network, email cwla.lambda.network@ lambdalegal.org Human Rights Campaign Fund Foundation. (2009). Prom- ising practices in adoption and foster care: A compre- DVD Resources hensive guide to policies and practices that welcome, affirm and support lesbian, gay, bisexual and transgender “Breaking the Silence: LGBTQ Foster Youth Tell Their foster and adoptive parents. Available from http://www. Stories: A Tool for Training Care Providers on Work- hrc.org/documents/HRC-Foundation_Promising_Prac- ing Effectively with LGBTQ Youth,” DVD and Resource tices_Guide_3rd_Edition_Printer_Friendly.pdf CD. This DVD features ten LGBTQ youths, who were formerly in foster care, who tell their stories of success and Marksamer, J. (2011). A place of respect: A guide for group disappointments in the foster care system and generously care facilities serving transgender and gender non-con- provide viewers with recommendations for improving forming youth. San Francisco & New York City: Nation- service delivery. Each DVD comes with a CD contain- al Center for Lesbian Rights and the Sylvia Rivera Law ing additional training tools and resources. Available free Project. Available from http://www.nclrights.org/site/ from the National Center for Lesbian Rights, http://www. DocServer/A_Place_of_Respect.pdf?docID=8301. nclrights.org

National Alliance to End Homelessness, Lambda Legal De- “LEAD with Love,” a free online 35-minute documentary fense and Education Fund, National Center for Lesbian film, written and produced by Dr. David Huebner, a clinical Rights, and National Network for Youth (2009). National psychologist and professor at the University of Utah, and recommended best practices for serving LGBT homeless directed by Dr. Jenny Mackenzie, an award-winning documentary filmmaker, aims to strengthen families through youth. New York: Authors. Available from http://www. their child’s coming out process by providing information, endhomelessness.org/content/article/detail/2239 practical guidance, and comfort. and assist families that are National Center for Lesbian Rights. (2006). Model anti-ha- struggling with their child’s sexual orientation. The film rassment and non-discrimination policy for child welfare features four families that are struggling with their child’s or juvenile justice agencies. Available from National sexual orientation, sharing parental and child reactions, and Center for Lesbian Rights, http://www.nclrights.org. incorporates interviews with clergy, educators and psy- chologists. Viewers can download a guide for parents and Training Curricula a directory of additional resources. LEAD stands for Let your affection show; Express your pain away from your Jackson, R.A., McCloskey, K.A., & McHaelen, R.P. (2011). child; Avoid rejecting behaviors; and Do good before you A sexuality & gender diversity training program: In- feel good. The film can be viewed athttp://leadwithlove - creasing the competency of mental health professionals: film.com/ A guide for parents is available from http://www. Manual & CD-ROM. Sarasota, FL: Professional Re- leadwithlovefilm.com/pdf/summary.pdf source Exchange. Available from http://www.prpress. com “We Are….GLBTQ” is an online 40-minute training video available from the Washington State Department of Social McHaelen, R., & Elze, D. (2009). Moving the margins: and Health Services that features LGBTQ adolescents in Curriculum for child welfare services with LGBTQQ out-of-home care sharing their stories about their coming youth in out-of-home care. National Association of So- out experiences, the reactions of their biological and foster cial Workers and Lambda Legal Defense and Education families, and their identity development processes. Pro- Fund. Available from Lambda Legal Defense & Educa- fessionals present basic information on terminology and tion Fund, http://www.lambdalegal.org the developmental needs of LGBTQ youth, and foster and adoptive parents present their perspectives. The film can be CWLA/Lambda Legal National LGBTQ Advisory viewed and the discussion downloaded at http://www.dshs. Network wa.gov/ca/partners/trainingVid.asp The Child Welfare League of America//Lambda Legal Na- tional LGBTQ Advisory Network is comprised of educators, researchers, social services professionals, and advo- cates committed to improving service delivery for LGBTQ youth across multiple systems of care, particularly in the child welfare and juvenile justice systems. Through the network, members share research reports and other resources, programmatic and policy updates, legislative alerts on mat- ters affecting LGBTQ youth, and hold periodic conference

10 National Resource Center for In-Home Services

REFERENCES Gallegos, A., White. C.R., Ryan, C., O’Brien, K., Pecora, P.J., & Thomas, P. (2011). Exploring the experiences of Berberet, H. M. (2006). Putting the pieces together for lesbian, gay, bisexual, and questioning adolescents in queer youth: A model of integrated assessment of need foster care. Journal of Family Social Work, 14, 226-236. and program planning. Child Welfare, 85, 361-384. Garofalo, R., Deleon, J., Osmer, E., Doll, M., & Harper, G. Clatts, M.C., Davis, W.R., Sotheran, J.L., & Atillasoy, A. (2006). Overlooked, misunderstood and at-risk: Explor- (1998). Correlates and distribution of HIV risk behaviors ing the lives and HIV risk of ethnic minority male-to- among homeless youths in New York City: Implications female transgender youth. Journal of Adolescent Health, for prevention and policy. Child Welfare, 77, 195-207. 38, 230-236. Cochran, B.N., Stewart, A.J., Ginzler, J.A., & Cauce, A.M. Greytak, E.A., Kosciw, J.G., & Diaz, E.M. (2009). Harsh (2002). Challenges faced by homeless sexual minorities: realities: The experiences of transgender youth in our Comparison of gay, lesbian, bisexual, and transgender nation’s schools. New York: Gay Lesbian and Straight homeless adolescents with their heterosexual counter- Education Network. parts. American Journal of Public Health, 92, 773-777. Grossman, A.H., & D’Augelli, A.R. (2006). Transgender Courtney, M.E., Dworsky, A., Lee, J.S., & Raap, M. youth: Invisible and vulnerable. Journal of Homosexual- (2010). Midwest evaluation of the adult functioning ity, 51, 111-128. of former foster youth: Outcomes at ages 23 and 24. Chicago: Chapin Hall at the University of Chicago. Grossman, A.H., & D’Augelli, A.R. (2007). Transgender Retrieved from http://www.chapinhall.org/sites/default/ youth and life-threatening behaviors. Suicide and Life- files/Midwest_Study_Age_23_24.pdf Threatening Behavior, 37, 527-537. Courtney, M.E., Dworsky, A., Ruth, G., Keller, T., Hav- Grossman, A.H., D’Augelli, A.R., Howell, T.J., & Hub- licek, J., & Bost, N. (2005). Midwest evaluation of the bard, S. (2005). Parents’ reactions to transgender youths’ adult functioning of former foster youth: Outcomes at gender nonconforming expression and identity. Journal age 19. Chicago: Chapin Hall at the University of Chi- of Gay & Lesbian Social Services, 18, 3-16. cago. Retrieved from http://www.chapinhall.org/sites/ default/files/ChapinHallDocument_4.pdf Hershberger, S.L., & D’Augelli, A.R. (2000). Issues in counseling lesbian, gay, and bisexual adolescents. In D’Augelli, A.R., Grossman, A.H., & Starks, M.T. (2005). R.M. Perez, K.A. DeBord, & K.J. Bieschke (Eds.), Parents’ awareness of lesbian, gay, and bisexual youths’ Handbook of counseling and psychotherapy with les- sexual orientation. Journal of Marriage and Family, 67, bian, gay, and bisexual clients (pp. 225-247). Washing- 474-482. ton, DC: American Psychological Association. DeCrescenzo, T., & Mallon, G.P. (2002). Serving transgen- Irvine, A. (2010). “We’ve had three of them”: Address- der youth: The role of child welfare systems – Proceed- ing the invisibility of lesbian, gay, bisexual and gender ings of a colloquium – September 2000.. Washington, non-conforming youths in the juvenile justice system. DC: Child Welfare League of America. Columbia Journal of Gender and Law, 19(3), 6745-701. Diamond, L.M. (2003). New paradigms for research on Irwin, C.E., Burg, S.J., & Cart, C.U. (2002). America’s heterosexual and sexual minority development. Journal adolescents: Where have we been, where are we going? of Clinical Child and Adolescent Psychology, 32, 490- Journal of Adolescent Health, 31, 91-121. 498. Jacobs, J., & Freundlich, M. (2006). Achieving permanen- Elze, D. (2006) Working with gay, lesbian, bisexual and cy for LGBTQ youth. Child Welfare, 85, 299–316. transgender students. In C.Franklin, M.B. Harris, & P. Allen-Meares (Eds.), The School Services Sourcebook: Laumann E.O, Gagnon J.H., Michael R.T., & Michaels,S. A Guide for School-Based Professionals (pp. 861-870). (1994). The social organization of sexuality. The Uni- New York: Oxford University Press. versity of Chicago Press: Chicago. Elze, D. (2007). Research with sexual minority youths: Lev, A.I. (2004). Transgender emergence: Therapeutic Where do we go from here? Journal of Gay and Lesbian guidelines for working with gender variant people and Social Services, 18(2), 73-99. their families. New York: Haworth Press. Feinstein, R., Greenblatt, A., Hass, L., Kohn, S., & Rana, J. Majd, K., Marksamer, J., & Reyes, C. (2009). Hidden in- (2001). Justice for all? A report on lesbian, gay, bi- justice: Lesbian, gay, bisexual, and transgender youth in sexual and transgendered youth in the New York juvenile juvenile courts. San Francisco: Legal Services for Chil- justice system. New York: Urban Justice Center. Re- dren, National Juvenile Defender Center, and National trieved from http://www.urbanjustice.org/publications/ Center for Lesbian Rights. Retrieved from http://www. index,html. equityproject.org/pdfs/hidden_injustice.pdf Freeman, L., & Hamilton, D. (2008). A count of home- Mallon, G.P. (1998). We don’t exactly get the welcome less youth in New York City. New York: Empire State wagon: The experiences of gay and lesbian adolescents Coalition of Youth and Family Services. Retrieved from in child welfare systems. New York: Columbia Univer- http://www.citylimits.org/images_pdfs/pdfs/HomelessY- sity Press. outh.pdf

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Mallon, G.P. (1999). Let’s get this straight: A gay- and Ryan, C., Russell, S.T., Huebner, D., Diaz, R.M., & San- lesbian-affirming approach to child welfare.New York: chez, J. (2010). Family acceptance in adolescence and Columbia University Press. the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23, 205-213. Mallon, G.P., Aledort, N., & Ferrera, M. (2002). There’s no place like home: Achieving safety, permanency, and Saewyc, E.M., Bauer, G.R., Skay, C.L., Bearinger. L.H., well-being for lesbian and gay adolescents in out-of- Resnick, M.D., Reis, E., & Murphy, A. (2004). Mea- home care settings. Child Welfare, 51, 407-439. suring sexual orientation in adolescent health surveys: Evaluation of eight school-based surveys. Journal of Mallon, G.P., & DeCrescenzo, T. (2009). Social work Adolescent Health, 35, 345.e1-345.e15. practice with transgender and gender variant children and youth. In G. P. Mallon (Ed.), Social work practice Saewyc, E.M., Skay, C.L., Pettingell, S.L., Reis, E.A., with transgender and gender variant youth (2nd ed.) (pp. Bearinger, L., Resnick, M. , Murphy, A., & Combs, L. 65-86). New York: Routledge. (2006). Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United Ragg, D.M., Patrick, D., & Ziefert, M. (2006). Slamming States and Canada. Child Welfare.85, 195-213. the closet door: Working with gay and lesbian youth in care. Child Welfare, 85, 243-265. Savin-Williams, R.C. (2005). The new gay teenager. Cam- bridge, MA: Harvard University Press. Ray, N. (2006). Lesbian, gay, bisexual and transgender youth: An epidemic of homelessness. New York: Na- Sullivan, C., Sommer, S., & Moff, J. (2001). Youth in the tional Gay and Lesbian Task Force Policy Institute and margins: A report on the unmet needs of lesbian, gay, bi- the National Coalition for the Homeless. Retrieved from sexual, and transgender adolescents in foster care. New http://www.thetaskforce//downloads/HomelessYouth.pdf York: Lambda Legal Defense and Education Fund. Re- trieved from http://www.lambdalegal.org/our-work/pub- Rew, L., Whittaker, T.A., Taylor-Seehafer, M.A., & Smith, lications/youth-in-the-margins.html L.R. (2005). Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless Thrane, L.E., Hoyt, D.R., Whitbeck, L.B., & Yoder, K.A. youth. Journal for Specialists in Pediatric Nursing, 10, (2006). Impact of family abuse on running away, devi- 11-19. ance, and street victimization among homeless rural and urban youth. Child Abuse & Neglect, 30, 1117-1128. Rosario, M., Schrimshaw, E.W., & Hunter, J. (2011a). Dif- ferent patterns of sexual identity development over time: Tyler, K., Hoyt, D., Whitbeck, L., & Cauce, A. (2001). The Implications for the psychological adjustment of lesbian, impact of childhood sexual abuse on later sexual victim- gay, and bisexual youths. Journal of Sex Research, 48, ization among runaway youth. Journal of Research on 3-15. Adolescence, 11, 151-176. Rosario, M., Schrimshaw, E.W., & Hunter, J. (2011b). Van Leeuwen, J.M., Boyle, S., Salomonsen-Sautel, S., Homelessness among lesbian, gay, and bisexual youth: Baker, N., Garcia, J.T., Hoffman, A., & Hopfer, C.J. Implications for subsequent internalizing and external- (2006). Lesbian, gay, and bisexual homeless youth: An izing symptoms. Journal of Youth and Adolescence. DOI eight-city public health perspective. Child Welfare, 85, 10.1007/s10964-011-9681-3. 151-170. Russell, S.T. (2005). Beyond risk: Resilience in the lives Whitbeck, L. B., Chen, X., Hoyt, D. R., Tyler, K. A., & of sexual minority youth. Journal of Gay and Lesbian Johnson, K. D. (2004). Mental disorder, subsistence Issues in Education, 2, 5-18. strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. The Journal Ryan, C. (2009). Helping families support their lesbian, of Sex Research, 41(4), 329-342. gay, bisexual, and transgender (LGBT) children. Washington, DC: National Center for Cultural Com- Whitbeck, L. B., Hoyt, D. R., Johnson, K.D., & Chen, X. petence, Georgetown University Center for Child and (2007). Victimization and posttraumatic stress disorder Human Development. Retrieved from http://www11. among runaway and homeless adolescents. Violence and georgetown.edu/research/gucchd/nccc/documents/ Victims, 22, 721-734. LGBT_Brief.pdf Wilber, S., Ryan, C., & Marksamer, J. (2006). CWLA best Ryan, C. (2010). Engaging families to support lesbian, gay, practice guidelines: Serving LGBT youth in out-of-home bisexual, and transgender youth: The Family Acceptance care. Washington, DC: Child Welfare League of Ameri- Project. The Prevention Researcher, 17(4), 11-13. ca. Retrieved from http://www.cwla.org/pubs/pubdetails. asp?PUBID=0951 Ryan, C., & Futterman, D. (1998). Lesbian & gay youth: Care & counseling. New York: Columbia University Woronoff, R., Estrada, R., & Sommer, S. (2006). Out Press. of the margins: A report on regional listening forums highlighting the experiences of lesbian, gay, bisexual, Ryan, C., Huebner, D., Diaz, R.M., & Sanchez, J. (2009). transgender and questioning youth in care. New York: Family rejection as a predictor of negative health out- Lambda Legal Defense and Education Fund & the Child comes in White and Latino lesbian, gay, and bisexual Welfare League of America. Retrieved from http:// young adults. Pediatrics, (123), 346-352. www.lambdalegal.org/ourwork/publications/page. jsp?itemID=32007311

12 IN PRACTICE In-Home Services With LGBT Youth and Their Families

SELF-EDUCATION AND SELF-AWARENESS tity. Family members can increase their acceptance with supportive interventions. • Recognize that family, school and community stigmatization of a youth’s actual or perceived • Educate family members about the deleteri- sexual orientation or gender identity diversity ous effects of rejecting behaviors on the health may underlie youths’ truancy, runaway behavior, and well-being of LGBTQ youth. Share and re- substance use, other acting out behavior, abuse view with them the free booklet from the Family and neglect and familial disruption. Acceptance ProjectTM (see Resources for Further Information at the end of this brief). • Explore your own biases, feelings, beliefs and attitudes toward diversity in sexual orientation, • Correct myths and stereotypes and provide psy- gender identity, and gender expression. choeducational support and information.

• Educate yourself about the differences be- • Help family members decrease highly reject- tween sexual orientation and gender identity, ing behaviors and increase accepting behaviors. the diversity and complexity of sexual and gen- Provide family members with empathic support der identities, the psychosocial strengths and for feelings of grief, loss, anger, fear, shame, and needs of LGBTQ youth and potential foci of guilt. interventions. • Refer family members to knowledgeable com- • Identify mental and physical health care munity professionals and LGBTQ-affirmative professionals who specialize in serving transgen- spiritual/religious leaders. der children and adolescents. • Normalize diversity in sexual orientation, gen- WITH FAMILY MEMBERS der expression, and gender identity. Help family members accept their child’s complexity and not • Explore with family members their reactions pathologize their child. to the LGBTQ child’s sexual orientation and/or gender identity. • Discourage family members from seeking aver- sive treatments that claim to change sexual ori- • Do not assume that family preservation efforts entation and gender variant expression. Educate or reconnection with family members are destined family members on the harmful effects of these to fail if family members react negatively to their approaches. children’s sexual orientation and/or gender iden-

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WITH YOUTH • Help youth envision and plan for a positive and productive future. • Use inclusive language with youth when exploring their romantic and sexual desires, behaviors, ASSESS FAMILY-RELATED PSYCHOSOCIAL concerns, and identities (e.g., “partner,” “special STRENGTHS AND NEEDS person,” or “girlfriend or boyfriend”; “Have you • Explore cultural values, beliefs and meanings been dating anyone? A girl? A boy? Girls and related to sexuality, gender roles, marriage, chil- boys?” “Have you been feeling attracted to girls drearing, and familial expectations of children, or boys, or to both?”) When discussing sexual be- adolescents and adults. haviors, ask all youth, “Have you been/are you sexually active with males, females, or with both • Explore familial awareness of the youth’s sex- males and females?” ual orientation or gender identity (e.g., Do family members know? Were they told? By whom? Did • Affirm, validate, and accept youths’ expressions they find out another way? How long have they of gender variance; same-gender attractions, de- known? Reactions?) sires, and behaviors; and self-identification and confusion. • Assess for actual or anticipated risks (e.g., violence, being thrown out of the house) and benefits • With transgender youth, respect their wishes by (e.g., better relationships) in disclosing. using their preferred names and pronouns, and do not demand or enforce stereotypical gender be- • Explore family members’ actual or anticipated havior. attitudes.

• Ask LGBTQ youth about their relationships • Ask about the presence of other LGBTQ people with their family members, the extent to which in the lives of family members. they are “out” to family members, and their family members’ reactions to their disclosure. • Assess for other family stressors (e.g., substance use, mental illness, family violence, finan- • Treat youths’ sexual orientation and gender cial stress, divorce). identity the way you handle any other confidential information. If disclosure is necessary to protect • Explore youths’ histories of physical, sexual, or secure a benefit for the youth, disclosure should and/or emotional abuse and/or neglect. not occur without actively engaging the youth in • Assess family members’ coping responses to a discussion about risks and benefits and securing crises and other challenges. the youth’s permission. (DeCrescenzo & Mallon, 2002; Elze, 2006; Her- • Correct myths and stereotypes and provide psy- shberger & D’Augelli, 2000; Lev, 2004; Mallon choeducational support and information. & DeCrescenzo, 2009; Ryan, 2009, 2010; Ryan • Help youth find social support, build social con- & Futterman, 1998; Wilber, Ryan, & Marksamer, nections, and find allies. 2006).

• Help youth build adaptive coping strategies to manage stigmatization.